Mood Chart

Adapted from Sachs, G (1996): J. Clin. Psychopharm. 16:2(suppl 1) p47S

Exercise /Medication
Date Energy/Mood Sleep Irritability Events/Notes/Observations
(enter amounts, note dose changes)
Exercise How med 1 med 2 med 3 med 4 (can use two check marks: check one, or
type long
worst and best for each day) 0-3 scale Questions to ask, connections you suspect;
enter hours
Walk Low Agitation/
Swim energy/mood anxiety/ “up”
(circle for

increased sleep
Run or significant events that might affect mood

normal sleep
impaired

impaired

impaired

impaired
menses)

normal
cannot

cannot
mood
— interactions, successes, disappointments,

work

work
Bike

not

not

insomnia
Etc. anniversaries, illness, losses, etc.

mg mg mg mg +++ ++ + + ++ +++
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31 weight =